J Korean Orthop Assoc.  2007 Oct;42(5):653-658. 10.4055/jkoa.2007.42.5.653.

Treatment of the Femoral Shaft Nonunion Occurredafter Intramedullary Nailing

• Jung HG
• Kim DJ
• Kim BH
• Chung YY

• KMID: 2186473
• DOI: http://doi.org/10.4055/jkoa.2007.42.5.653

Abstract

PURPOSE: To evaluate of efficacy of the treatment options for a femoral shaft nonunion occurring after intramedullary nailing. MATERIAL AND METHODS: Thirty-one patients with nonunion of a femoral shaft fracture, who had been treated with interlocking intramedullary nailing from January 1996 to December 2000, were examined. Twenty-six had oligotrophic nonunion and five were hypervascular. Forty-five procedures were performed for 31 nonunions; bone grafting for 14, exchange nailing for 13, plate augmentation and bone grafting for 14 and dynamization for 4 cases.
RESULTS
The success rate after a single procedure was only 58%. The four dynamization cases failed to unite. Seven of the 13 (54%) nonunion cases treated with nail exchange healed satisfactorily. All cases treated with plate augmentation and bone grafting achieved successful union. The mean period from fracture to union was 20 months.
CONCLUSION
Exchange nailing is not always a reliable procedure for treating nonunion of a femoral shaft fracture. Plate augmentation and bone grafting were found to be a successful mode of therapy for the femoral shaft nonunion without complications.

Keyword

Femur; NONUNION; INTRAMEDULLARY nailing; Exchange nailing; Plate augmentation

MeSH Terms

Bone Transplantation
Femur
Fracture Fixation, Intramedullary*
Humans

Figure

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  Fig. 1 (A) Forty-six year old man with a comminuted femoral shaft fracture. The fracture had been fixed with a reamed intramedullary nail 9 month earlier. (B) The patient complained of pain at the fracture site and the fracture line remained. (C) The nonunion was treated with exchange nailing. (D) Four months after exchange nailing, the nonunion was healed.

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  Fig. 2 (A) Thirty-two year old man with a femoral shaft nonunion. The fracture had been fixed with a reamed intrmedullary interlocking nail 7 months earlier. (B) The nonunion was treated with reamed exchange nailing but it was not healed. (C) AO 6 holes plate was fixed across the nonunion site with autogenous bone grafting. (D) The nonunion was healed without complications 6 months after surgery.

Reference

1. Baixauli F, Baixauli EJ, Sánchez-Alepuz E, Baixauli F. Interlocked intramedullary nailing for treatment of open femoral shaft fractures. Clin Orthop Relat Res. 1998. 350:67–73.

2. Banaszkiewicz PA, Sabboubeh A, McLeod I, Maffulli N. Femoral exchange nailing for aseptic non-union: not the end to all problems. Injury. 2003. 34:349–356.

3. Basumallick MN, Bandopadhyay A. Effect of dynamization in open interlocking nailing of femoral fractures. A prospective randomized comparative study of 50 cases with a 2-year follow-up. Acta Orthop Belg. 2002. 68:42–48.

4. Bellabarba C, Ricci WM, Bolhofner BR. Results of indirect reduction and plating of femoral shaft nonunions after intramedullary nailing. J Orthop Trauma. 2001. 15:254–263.

5. Brinker MR, O'Connor DP. Exchange nailing of ununited fractures. J Bone Joint Surg Am. 2007. 89:177–188.

6. Cole JD. Browner BD, editor. The vascular response of bone to internal fixation. The science and practice of intramedullary nailing. 2nd ed. Williams and Wilkins;43–69.

7. Hak DJ, Lee SS, Goulet JA. Success of exchange reamed intramedullary nailing for femoral shaft nonunion or delayed union. J Orthop Trauma. 2000. 14:178–182.

8. Heiple KG, Figgie HE, Lacey SH, Figgie MP. Femoral shaft nonunion treated by a fluted intramedullary rod. Clin Orthop Relat Res. 1985. 194:218–225.

9. Johnson KD, Tencer AF, Blementhal S, August A, Johnston DW. Biomechanical performance of locked intramedullary nail systems in comminuted femoral shaft fractures. Clin Orthop Relat Res. 1986. 206:151–161.

10. Koval KJ, Seligson D, Rosen H, Fee K. Distal femoral nonunion: treatment with a retrograde inserted locked intramedullary nail. J Orthop Trauma. 1995. 9:285–291.

11. Mercado EM, Lim EV, Stern PJ, Aquino NJ. Exchange nailing for failure of initially rodded tibial shaft fractures. Orthopedics. 2001. 24:757–762.

12. Ueng SW, Chao EK, Lee SS, Shih CH. Augmentative plate fixation for the management of femoral nonunion after intramedullary nailing. J Trauma. 1997. 43:640–644.

13. Ueng SW, Shih CH. Augmentative plate fixation for the management of femoral nonunion with broken interlocking nail. J Trauma. 1998. 45:747–752.

14. Webb LX, Winquist RA, Hansen ST. Intramedullary nailing and reaming for delayed union or nonunion of the femoral shaft. A report of 105 consecutive cases. Clin Orthop Relat Res. 1986. 212:133–141.

15. Weresh MJ, Hakanson R, Stover MD, Sims SH, Kellam JF, Bosse MJ. Failure of exchange reamed intramedullary nails for ununited femoral shaft fractures. J Orthop Trauma. 2000. 14:335–338.

16. Winquist RA, Hansen ST. Comminuted fractures of the femoral shaft treated by intramedullary nailing. Orthop Clin North Am. 1980. 11:633–648.

17. Wolinsky PR, McCarty E, Shyr Y, Johnson K. Reamed intramedullary nailing of the femur: 551 cases. J Trauma. 1999. 46:392–399.

18. Wu CC, Chen WJ. Treatment of femoral shaft aseptic nonunions: comparison between closed and open bone-grafting techniques. J Trauma. 1997. 43:112–116.

19. Zuckerman JD, Veith RG, Johnson KD, Bach AW, Hansen ST, Solvik S. Treatment of unstable femoral shaft fractures with closed interlocking intramedullary nailing. J Orthop Trauma. 1987. 1:209–218.